Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy

Authors

  • Ioannis Patras Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Johan Abrahamsson Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Axel Gerdtsson Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Martin Nyberg Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Ymir Saemundsson Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Elin Ståhl Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Anne Sörenby Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Åsa Warnolf Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Johannes Bobjer Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden
  • Fredrik Liedberg Department of Urology Skåne University Hospital, Malmö, and Institution of Translational Medicine, Lund University, Malmö, Sweden

DOI:

https://doi.org/10.2340/sju.v59.25973

Keywords:

UTUC, Radical nephroureterectomy

Abstract

Objective: Disease recurrence, particularly intravesical recurrence (IVR) after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), is common. We investigated whether violations of onco-surgical principles before or during RNU, collectively referred to as surgical violation (SV), were associated with survival outcomes. 

Material and methods: Data from a consecutive series of patients who underwent RNU for UTUC 2001–2012 at Skåne University Hospital Lund/Malmö were collected. Preoperative insertion of a nephrostomy tube, opening the urinary tract during surgery or refraining from excising the distal ureter were considered as SVs. Survival outcomes in patients with and without SV (IVR-free [IVRFS], disease-specific [DSS] and overall survival [OS]) were assessed using multivariate Cox regression analyses (adjusted for tumour stage group, prior or concomitant bladder cancer, comorbidity and preoperative urinary cytology).

Results: Of 150 patients, 47 (31%) were subjected to at least one SV. Overall, SV was not associated with IVRFS (HR 0.81, 95% CI 0.4–1.6) but with worse DSS (HR 1.9, 95% CI 1.03–3.7) and OS (HR 1.9, 95% CI 1.2–3) in multivariable analysis. Additional analyses with a broader definition of SV including also preoperative instrumentation of the upper urinary tract (ureteroscopy and/or double J stenting) showed similar outcomes for DSS (HR 2.1, 95% CI 1.1–4.3).

Conclusion: Worse survival outcomes, despite no difference in IVR, for patients that were subjected to the violation of sound onco-surgical principles before or during RNU for UTUC strengthen the notion that adhering to such principles is a cornerstone in upper tract urothelial cancer surgery.

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Published

2024-06-19

How to Cite

Patras, I., Abrahamsson, J., Gerdtsson, A., Nyberg, M., Saemundsson, Y., Ståhl, E., … Liedberg, F. (2024). Violation of onco-surgical principles is associated with survival outcomes in upper tract urothelial carcinomas after radical nephroureterectomy. Scandinavian Journal of Urology, 59, 131–136. https://doi.org/10.2340/sju.v59.25973

Issue

Vol. 59 (2024)

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Original research article

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Copyright (c) 2024 Ioannis Patras, Johan Abrahamsson, Axel Gerdtsson, Martin Nyberg, Ymir Saemundsson, Elin Ståhl, Anne Sörenby, Åsa Warnolf, Johannes Bobjer, Fredrik Liedberg

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This work is licensed under a Creative Commons Attribution 4.0 International License.

Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

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